TJPRC: International Journal of General

Pediatrics and Medicine (TJPRC: IJGPM)

Vol. 2, Issue 1, Jun 2017, 7-10
TJPRC Pvt. Ltd.

SERUM MAGNESIUM LEVEL IN FEBRILE CONVULSION

GOUTHAM A S1, PRAGYEE DHINGRA2 & POORNIMA SHANKAR3

1,2
Post graduates, Department of Pediatrics, KIMS Hospital and research centre, Bangalore, India
3
Associate Professor, Department of Pediatrics, KIMS Hospital and research centre, Bangalore, India
ABSTRACT
Aim

To study relation between serum magnesium levels and febrile convulsion and to compare serum magnesium
level in children with febrile convulsion to febrile children with no convulsion.

Material and Methods

A prospective case control study done in Kempegowda Institutes of Medical science, Bangalore between October
2015- October 2016 where 2 groups were made of 45 children each as case and control group. Informed consent was
taken by all parents and detailed history, past , birth and family history was taken and serum magnesium levels were done
by Roche 9180 electrolyte analyser.

Results

Original Article
Mean age of cases with febrile convulsion and febrile patients without seizures were 1.97years (+/-) 1.33years
and 2.01years (+ /-)1.02 years respectively. there were 24 male and 21 female babies in group 1 and 23 male and 22
females in other group. the mean age and sex were similar in both groups. Mean level of magnesium were 1.97+_0.24 and
2.19 +_ 0.20 in cases with febrile convulsion and febrile patients without seizures respectively and there was significant
differences.

Conclusions

Febrile convulsion is the most common type of convulsion in children. We got a positive co relation between
levels of serum magnesium and febrile convulsion. However more studies at a larger level required to establish a strong
correlation between the two.

KEYWORDS: Serum Magnesium Levels, Febrile Convulsion & Convulsion

Received: Feb 06, 2017; Accepted: Mar 30, 2017; Published: Apr 05, 2017; Paper Id.: TJPRC:IJGPMJUN20172

INTRODUCTION

Febrile convulsion are the most common type of seizures and occur in 2-4 % of children [1] Factors like
genetics, neurotransmitters level changes and few trace elements have been introduced as a possible cause [2-4],
however, the main cause not known yet. Because 30-40% of children who experience a febrile convulsion will
have a recurrence, it makes febrile convulsion an important issue to understand and prevent [5]In the past, blood
tests like electrolytes were not suggested, but recently several studies have shown the effect of GABA, ZN, and Fe
in developing febrile convulsion offering possible interference of other trace elements. Magnesium is the fourth
most common cation in the body and the third most intra cellular cation .50-60% of body magnesium is in bone
where it serves as reservoir because 30% is exchangeable, allowing movement to extra cellular space. Most intra

www.tjprc.org editor@tjpr.corg
8 Goutham. A. S, Pragyee Dhingra & Poornima Shankar

cellular magnesium is bound to protein, of about 25% is exchangeable. Because cells with higher metabolic rate have
higher magnesium, most of it is present in muscle and lever. The normal plasma magnesium is 1.5-2.3 mg/dl. Magnesium
is essential for membrane utilization and nerve conduction [1].By definition by AAP criteria , the child should have a
febrile illness or certainly fever, neurologically healthy between 6 month to 5 years of age whose seizure is brief (<15min)
, generalized and occurs only once (simple febrile convulsion) or more times( complex febrile convulsions) during a 24
hour period during a fever[6].The following objectives to correlate the hypothesis , to find co relation between serum
magnesium level and febrile convulsion and to compare level of serum magnesium between children with febrile
convulsion and febrile children with no convulsions.

METHOD

This was a prospective case-control study done in Kempegowda Institute of Medical Science, Bangalore between
October 2015 to October 2016 which included two groups of patients with 6-60 month of age with febrile convulsion and
fever without seizure respectively. Forty five cases were enrolled in each groups.

Inclusion Criteria

Patients between 6 month to 5 years of age of either sex.

Exclusion Criteria

Electrolyte imbalance due to gastrointestinal disease

CNS infections ( encephalitis , meningitis)

Metabolic disorder

Detailed history of presenting complaints, type and duration of seizure, past history, birth history and family
history was taken . Thorough physical examination was done. Children with congenital or acquired illness were
excluded. 2ml of blood was drawn under aseptic precaution and serum magnesium level were measured using Roche 9180
electrolyte analyser. The analysis was done by STATA11.1, data were analysed using T test and Chi square

RESULTS

Mean age of cases with febrile convulsion and febrile patients without seizures were 1.97years +_ 1.33 years and
2.01years + _ 1.02 years respectively. There were 24 male and 21 female babies in group-I and 23 male and 22 females in
group-II. The mean age and sex were similar in both groups.

Mean level of magnesium were 1.97+_0.24 and 2.19 +_ 0.20 in cases with febrile convulsion and febrile patients
without seizures respectively and there was significant difference (p=0.001)

Table 1
VARIABLE GROUP 1 GROUP 2
Serum Mg 1.97+_0.24 2.19 +_ 0.20

www.tjprc.org editor@tjpr.corg
Serum Magnesium Level in Febrile Convulsion 9

Figure 1

DISCUSSIONS

Action of magnesium level on nervous system is that, it reduces the release of acetyl choline at the neuromuscular
junction by antagonizing calcium ions at presynaptic junction, reduced excitability of nerves, and acts as anticonvulsants,
reverses cerebral vasospasm [7].It is suggested that alteration in magnesium concentration in plasma and intracellular
matrix give rise to functional impairment of the cell membranes, which might trigger seizures. Recent evidences indicate
that the deficiency of magnesium play a significant role in febrile convulsion [7, 8].Magnesium plays an important role in
establishing electrical potential across cell membrane. It also affects calcium metabolism the production of cyclic
adenosine monophosphate is magnesium dependent which in turn controls release of parathyroid hormone. [7, 9]. Our
study showed difference in magnesium level in between two groups which is similar to Studies done by Prakash, Talebian
and Sadinegad [10-12]. However studies done by Burhanoglu, Donalson, Rutter and Heipertz showed no difference in
magnesium level [3, 13-15].A recent study done in Egypt in 2013 in Ain Shams University and National research centre
Egypt to asses blood levels of trace elements in familial febrile convulsion concluded that serum selenium and magnesium
levels were significant low and logistic regression model in their study showed that selenium and magnesium have
protective effect in children with febrile convulsion [16].

CONCLUSIONS

Febrile convulsion is the most common type of convulsion in children. In our study, a positive correlation was
found between levels of serum magnesium and febrile convulsion. Hence children with low serum Magnesium level are
more prone to get febrile convulsions than children with normal Magnesium levelsHowever more studies at a larger level
required to establish a strong co relation between the two.

REFERENCES

1. Johnson M. Seizures in childhood. In : Kleigman R B Ehrman R, J Enson H , et al , editors. Nelson book of paediatrics 19th
ed. Philadelphia: Saunders Elsevier,2011

2. Loscher W, Rating D , Siemes H. GABA in cerebrospinal fluid of children with febrile convulsion . Epilepsia 1981;22(6):697-
702

www.tjprc.org editor@tjpr.corg
10 Goutham. A. S, Pragyee Dhingra & Poornima Shankar

3. Burhanoglu M, TutuncuogluS , Coker C , et al. Hypozincaemia in febrile convulsion . Eru J Pediatr 1996;155(6):498-501

4. Mol lay AH ,Dey R , Akhter S. et al. Zinc in CSF of patients with febrile convulsion. Indian J Pediatr 2002;69(10):859-61

5. Leung A, Robson L. Febrile seizures. J Pediatr Health Care 2007;21(4):250-5

6. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: theneurodiagnostic
evaluation of the child with a first simple febrile seizure. Paediatrics 1996;97(5):769-75

7. Benga I , Baltescu V , Tilinca R, et al. Plasma and cerebrospinal fluid concentrations of magnesium in epileptic children. J
Neuro Sci 1985;67(1):29-34

8. Suter C ,Klingman W . Neurologic manifestations of magnesium depletion states. N eurology (Minneapp) 1955;5:691-9

9. Chhaparwal BC, Kohli G, Potyowali JN , et al.Magnesium levels in serum and in CSF in febrile convulsions in infants and
children. Indian J Paediatrics,1971;38(5):241-15

10. Prakash Mishra O , Singhal D , Upadhyay RS et al. cerebro fluid zinc, magnesium , copper and gamma aminobutyric acid
level in febrile seizures. J PediatrNeurol 2007;5(1)39-44

11. Talebian A , Vakili Z, Talar S A et al. Assessment of relation between serum zinc and magnesium levels in children with febrile
convulsions. Iranian J Pathol 2009;4(4):157-60

12. Sadi nejad M , Mohsenzadeh A, Varkoohi A , et al. Assesing serum magnesium level in 9 months till 5 years old children with
febrile convulsion in spring 1383 J Iranian Children Dis 2002;13:00-00

13. Donaldson D , Trotman H , Barton M et al. Routine laboratory investigations in infants and children presenting with fever and
seizures at the university hospital of West Indies. West Indian Med J 2008;57(4):369-372

14. RutterN , Smales OR. Calcium, magnesium and glucose levels in bllod and CSF of children with febrile convulsions. Arch Dis
Child 1976;51(2):141-3

15. Heipertz R, Eichoff K, Karstens KH . Cerebrospinal fluid concentration of magnesium and inorganic phosphate in epilepsy. J
Neuro Sci 1979; 41 (1) :55-60 .

16. Macedonian Journal of Medical Sciences. 2014 Mar 15;7(1);68-73.Assessment of the level of GABA and some trace elements
in blood in children who suffer from familial febrile convulsion Osama et al

www.tjprc.org editor@tjpr.corg